Priority Nursing diagnosis Second Stage Labor

I am trying to sort between my nursing diagnoses for the second stage of labor. My instructors always say, "Think like a nurse. You're the nurse. What do you do?" Well, if it's second stage, I am helping the mom, encouraging her, telling when to push, using my fingers to stretch her vagina, monitoring the fetus to look for crowning, notifying the doctor when to come in, etc. I understand the priority interventions for the most part. I just don't know which nursing diagnosis matches those interventions.
Any suggestions?

Um, I hope my nurse doesn't stretch my vagina when I'm in the second stage of labor! lol.... All kidding aside, the first thing I thought about was acute pain, maybe anxiety/fear (maybe depending on if she's primigravida or multigravida)? Risk for impaired skin integrity (she could tear as you suggested.)....

Sep 14, '09

? I know you were trying to joke, but did I misunderstand something? I watched three vaginal deliveries this week and the nurse had her fingers in the vagina with each delivery. She said it was to help stretch things out.
If I am not understanding something correctly I would like to know.

Yes, I agree with pain, anxiety, etc. I have to decide which diagnosis is the priority and I find that difficult. Thanks for your input.

Sep 14, '09

Yeah, I've heard of that but I haven't actually seen it done in my rotation. I was just putting myself in the patient's shoes with that joke.... I would think pain would be the priority because you can't get a patient to focus if she's in pain. My professors always teach about pain as the priority....

Sep 16, '09

speaking from a stand point of a nursing student as well as someone who was in second stage labor a time or two...Your priority nursng diagnosis would be acute pain. Some of your interventions might be use of guided imagery, changing positions, providing patient with a focal point, helping patient with deep breathing etc.

Sep 16, '09

I'm still pre so take this with a grain of salt, but after two vaginal births I'd of probably kicked you if you put your fingers in my vagina to stretch it out. Perineum support, yeah great don't like tears, but hands in my vagina would've been a no go.

Sep 16, '09

My children are adopted, so I can't relate to the stretching aspect of this topic. All I know is not one of the moms I watched said a word about it. It seemed to be the standard procedure. I guess there are different ways the nurse supports the patient during delivery.

Sep 17, '09

I would of killed any nurse who tried to "stretch" my vagina! In 5 deliveries, I never had that happen!

I agree that pain would be #1.

In the meantime, I haven't had my OB rotation yet......

Sep 18, '09

The stretching comes in the final stage when you are pushing and the head is crowning. I remember the RN stretching the perineum However....their was an epidural involved...no stretching without analgesia!

Sep 19, '09

I was just thinking that when I gave birth to my daughter that someone could have stretched my bottom lip over my shoulders and I wouldnt have noticed...:chuckle

Jun 20, '10

I think you might have meant stretching the cervix. The vaginal wall expands on its own. The nurse caring for a laboring woman can use her fingers to stretch and gently manipulate the cervix back over the presenting part, usually the baby's head, toward crowning. It may prevent cervical tear. Analgesia is not necessary, and this is a common practice in most of the world, where analgesia in labor and delivery is almost non-existant.